不保留中上鼻甲的内镜鼻窦手术对慢性鼻-鼻窦炎伴鼻息肉患者生存质量及嗅觉功能的影响

发布时间：2018-03-14 02:13

本文选题：鼻窦炎　切入点：鼻息肉　出处：《临床耳鼻咽喉头颈外科杂志》2016年16期 　论文类型：期刊论文

【摘要】：目的:探讨不保留中、上鼻甲的内镜鼻窦手术对伴有嗅觉功能障碍的慢性全组鼻-鼻窦炎伴鼻息肉患者的生存质量以及嗅觉功能的影响。方法:81例伴嗅觉功能障碍的慢性全组鼻-鼻窦炎伴鼻息肉患者,均在全身麻醉下施行不保留中、上鼻甲的内镜鼻窦手术,围手术期给予鼻腔冲洗、局部激素喷鼻、口服黏液促排剂、酌情应用大环内酯类药物等规范化药物治疗。使用鼻腔鼻窦结局测试20(SNOT-20)中文版量表评估患者术前、术后的生存质量;使用TT嗅觉功能检测法及视觉模拟量表(VAS)评估患者的嗅觉功能。结果:通过SNOT-20量表评估,术前必须擤鼻涕、缺乏高质量睡眠、流黏稠鼻涕、难以进入睡眠、尴尬5个条目对患者生存质量的影响较为突出,术后第2周、术后1个月及术后3个月各项评分均较术前呈下降趋势(P0.05)。嗅觉情况:术前81例(162侧)患者中54例(108侧)嗅觉完全丧失,27例不同程度嗅觉减退(10例为双侧对称性嗅觉减退,17例为双侧不对称性嗅觉减退)。术后3个月嗅觉功能较术前改善者70例(86.4%),其中双侧嗅觉功能完全恢复者43例(53.1%),未完全恢复但有不同程度改善者27例(33.3%);嗅觉功能无改善者11例(13.6%)。术后随访1年以上者61例,术后1年嗅觉功能较术前改善者53例(86.9%),其中双侧嗅觉功能完全恢复者31例(50.8%),未完全恢复但有不同程度改善者22例(36.1%);嗅觉功能无改善者8例(13.1%);余20例正在随访中。TT嗅觉功能检测法术前与术后3个月比较差异有统计学意义(P0.05);VAS评分术前与术后3个月比较差异亦有统计学意义(P0.05)。结论:对于伴有嗅觉功能障碍的双侧慢性全组鼻-鼻窦炎伴鼻息肉患者,采用不保留中、上鼻甲的内镜鼻窦手术、结合围手术期规范的药物治疗,可以有效改善患者的生存质量和嗅觉功能。未发现因切除组织较多导致的过度通气及鼻干等症状。
[Abstract]:Objective: to explore the unreserved process, Effects of endoscopic sinus surgery on the quality of life and olfactory function in patients with chronic rhinosinusitis and nasal polyps with olfactory dysfunction methods 81 cases of chronic nasosinusitis with olfactory dysfunction. Patients with inflammation and nasal polyps, Under general anesthesia, endoscopic sinus surgery for upper turbinate was performed under general anesthesia. Nasal irrigation, local hormone spray, oral mucus excretion agent were given to the upper turbinate during the perioperative period. To evaluate the quality of life (QOL) of patients before and after operation with the Chinese version of the nasal sinus outcome test (20 SNOT-20). The olfactory function of patients was evaluated by TT olfactory function test and visual analogue scale (VASS). Results: SNOT-20 scale was used to evaluate the patients' olfactory function. Results: the patients must blow their noses before operation, lack of high quality sleep, runny and sticky nose, and difficult to get into sleep. The effect of embarrassing five items on the quality of life of the patients was significant, and the second week after operation, At 1 month after operation and 3 months after operation, the scores showed a downward trend (P 0.05). Olfactory status: 54 cases (108 sides) had complete loss of olfactory, and 10 cases had bilateral symmetry olfactory loss (n = 27). The olfactory function was improved in 70 cases 3 months after operation compared with that before operation in 70 cases, among which 43 cases had complete recovery of bilateral olfactory function, 27 cases had different degree of improvement of olfactory function. There were 11 cases with no improvement in function, 61 cases were followed up for more than one year after operation. One year after operation, the olfactory function was improved in 53 cases (86.9%), in which bilateral olfactory function was completely recovered in 31 cases (50.8%), incomplete but improved in 22 cases (36.1%), no improvement in 8 cases (13.1%), and 20 cases in follow-up. There was significant difference in VAS score between before and 3 months after olfactory function test. Conclusion: for patients with olfactory dysfunction, there is a significant difference in VAS scores before and 3 months after operation. Conclusion: for patients with olfactory dysfunction, there is no significant difference between them. Sinusitis with nasal polyps, Endoscopic sinus surgery without reservation of upper turbinate combined with standard drug therapy during perioperative period could effectively improve the quality of life and olfactory function of the patients. No symptoms such as hyperventilation and nasal dryness caused by excision of tissues were found.
【作者单位】：青岛大学附属医院耳鼻咽喉头颈外科;
【分类号】：R765.9

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